Provider Demographics
NPI:1194010447
Name:MUNSON, NICHOLE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MARIE
Last Name:MUNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 US HIGHWAY 41 W
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9483
Mailing Address - Country:US
Mailing Address - Phone:906-226-0095
Mailing Address - Fax:906-226-0095
Practice Address - Street 1:3250 US HIGHWAY 41 W
Practice Address - Street 2:T1334
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9483
Practice Address - Country:US
Practice Address - Phone:906-226-0095
Practice Address - Fax:906-226-0095
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist